INTERNATIONAL JOURNAL OF AND INFORMATION TECHNOLOGIES Issue 1, Volume 6, 2012

A demand for more personalized accessible medical in an aging world

M. Ianculescu, E. Lupeanu, A. Alexandru, E. Tudora, O. A. Coman, L. Coman

Abstract— Products and services based on new technology, such as I. INTRODUCTION ICT, are developing rapidly, and are used by large parts of the population – also by elderly people. Technology has potentials of raising the quality of elderly care and to make the services more he percentage of aging people on the total of the world adapted to individual needs and preferences. Medical Informatics is Tpopulation is rapidly increasing, leading to remarkable developing rapidly and has an increasingly possibility to play a role effects on the social structure and the health service. This in health and care-services. It can, when implemented and used with dramatic growth in numbers and proportions, increased life care, be a key resource in enabling elderly people to live long lives. expectancies, and energetic life styles, now enables us to live We want sustainable health and disability support services that can 20 to 25% of our lives in active retirement. Moreover, today's meet the needs of current and future generations of older people and physically and intellectually active younger generations predict support them to age positively. Ideas about aging have changed over that tomorrow's elderly population will be better educated, time. Aging people are increasingly becoming computer literate and more willing to be empowered about their own state of health and healthier, culturally literate and, as individuals, more way of living. This paper presents the most important features of discerning consumers. promoting a positive aging with the help of medical informatics. AGECVD, a health informatics system, proposes a complex integrative approach of physiological aging and atherosclerosis processes which can determine a multitude of cardiovascular events. The „Multidisciplinary Complex System for the Efficient Management of the Anti-Aging information (AgingNice)” allows the sharing of the knowledge concerning the specific research and the promotion of the theoretical and practical information, both among the stakeholders from the medical area and at the citizen’s level.

Keywords—Friendly ICT Technology, Aging people, Design for all, Empowerment

Fig.1 Percent of the population age 60 and over 2000-2025

Manuscript received September 23, 2011. This work was supported the Demographic changes are creating a new society, and these Ministry of Education, Research and Youth under PNCDI II Programme - profound social changes form a new reality: fewer young Partnerships, contract AGECVD, 62057/2008. Marilena Ianculescu is with the National Institute for Research and people, older workers, pensioners and very elderly people, Development in Informatics, 8-10 Averescu Avenue, 011455 Bucharest, composition of families (particularly evident in the growing Romania (corresponding author to provide phone: +4021-316-0736; fax: number of seniors living alone). Therefore it is compulsory for +4021-316-1030; e-mail: [email protected]). Elena Lupeanu is with the Institute of Gerontology and Geriatrics „Ana the aging people to remain active and healthy as long as Aslan”9, Calcarusani Str, Bucharest, Romania(e-mail: possible. There are many opportunities to be realized as future [email protected]). generations of older people are expected to be healthier, more Adriana Alexandru is with the National Institute for Research and skilled and educated, and remain more active in the workforce Development in Informatics, 8-10 Averescu Avenue, 011455 Bucharest, Romania (e-mail: [email protected]). than their predecessors. They are consuming more new goods Eleonora Tudora is with the National Institute for Research and and services and want to participate actively in social life. Development in Informatics, 8-10 Averescu Avenue, 011455 Bucharest, Unfortunately, for some aging people, full participation in Romania (e-mail: [email protected]). Oana Andreia Coman is with University of Medicine and Pharmacy “Carol society is prevented through low sense of worth or because of Davila” 8, Eroilor Sanitari Blvd, Bucharest Romania (e-mail: restricted opportunities. [email protected]). The concept of "positive aging" embraces a number of Laurentiu Coman is with University of Medicine and Pharmacy “Carol Davila” 8, Eroilor Sanitari Blvd, Bucharest Romania (e-mail: factors, including health, financial security, independence, [email protected]). self-fulfillment, community attitudes, personal safety and security, and the physical environment. Society as a whole has a lot to gain from these outcomes: a healthy, happy, and

62 INTERNATIONAL JOURNAL OF EDUCATION AND INFORMATION TECHNOLOGIES Issue 1, Volume 6, 2012 confident aging population contributes a wealth of expertise • Many older persons do not have the support of work and skills to the community and the workforce, places less colleagues or an IT department, and may need to learn demand on social services, and provides positive role models to use new technology on their own, perhaps with the for younger generations. help of friends/family. Even though the term “elderly” is accepted in many domains, • The anxiety that can result from coming into contact it has negative connotations and evokes such negative with something new might be quite a challenge for stereotypes. Negative stereotypes also exist about aging aging people in using ICT technology. people’ attitudes and capabilities regarding technology. • Aging people are often considered as a source of However, many older adults embrace new technologies and problems rather than a group still able to give their see benefits to using technologies [1]. contribution to the social and cultural life. New ICT technologies, designed with an explicit focus on • The early retirement as well as the decline of the needs of older adults, as well as their clinicians and employment percentages for people 50 years old and family caregivers, can help to meet the challenges of an over can be found in most of the countries. aging global population. The likelihood of a person developing a disability or Aging people are receptive to the concept of healthcare chronic illness increases with age. Many older adults are technology, as long as it continues to provide them with a disabled in one or more aspects of self-care and, in general, the sense of control and empowerment. The elderly want to retain elderly require more health care services and incur higher control over their lives and be involved in decision-making health care costs than younger people. about their care. As the elderly population increases and people live longer, The objectives of medical informatics are to contribute to a more people will require help with aspects of daily living and high-quality healthcare (especially patient care) and to the disease management. [2] The new aging people want to be gaining of new medical knowledge. By helping aging people active, mobile and self reluctant as far as possibly. The elders to become more proactive in managing their health, and of the future will have better financial resources and higher providing caregivers with the tools and information they need levels of education than before. to deliver care in any setting, from the home to the hospital, medical informatics can play an important role in addressing III. THE POSITIVE AGING, A WORLDWIDE GOAL the needs of the coming age wave. Positive aging is a term used to describe the process of Health informatics systems, like AGECVD presented in maintaining a positive attitude, feeling good about yourself, this paper, can have an important contribution in reaching a keeping fit and healthy, and engaging fully in life as you age. positive and healthy aging, with benefits both for individuals Some researchers and policy makers feel that enough time has and for our nowadays aging society. been spent on the negative aspects of aging and that the balance should be addressed by analyzing successful, or II. RISK FACTORS THAT AFFECT OUR AGING POPULATION positive aging (sometimes defined in terms of an overlapping Aging people are not homogenous and have various but separate dimension ‘health-related quality of life’), with interests and competences. They have changing disabilities, the aim of promoting well-being for future generations. [3] sometimes they are (or feel) isolated and excluded, they have Aging is often associated with many rewarding the impression being useless and they are often overwhelmed experiences. It is, however, also a time when significant by technology. changes might occur. Elderly people are most vulnerable to Facing the ICT technology, the most common risk factors social exclusion. that affect our aging population are: There are a number of ways to prevent, delay or manage • Digital literacy is considered nowadays one of the some of the physical, psychological, social and personal essential skills to allow people to effectively take part challenges people face as they age – some of these are in the modern society and to be involved in taking mentioned below: decisions about their own lives. Digital divide is • maintaining a positive attitude – it’s important that considered the gap between those who have access to aging people can make choices and have control and use the potentialities of ICT for their own over important aspects of their life; achievements, and those who are not in a position to • preventing digital exclusion - i.e. to prevent that access or use these potentialities. Elderly people are they could be left behind of the information society; often intimidated by the use ICT due to: their lack of • continuing working or to combine part-time work digital literacy, limitations imposed by their physical with retirement - therefore the main objective of new and mental disabilities, cost, geography, usability, policies should be the augmentation of employment including interface issues that arise from age-related rates at an older age; disabilities. • keeping the brain active, alert and flexible – this can • In some countries, the most important obstacle using promote good mental the new technology is the economic situation, which health and positive aging throughout the lifespan; does not allow older people to buy it. • staying connected - social interaction and relationships with others;

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• being empowered regarding their own health – this that users need to understand in order to learn to use implies access to information and knowledge and it the application; has as a result a better healthcare and self-esteem. • to provide additional interactive guidance back to help All these can be accomplished with the help of new them learn to use ICT technology. policies and ICT technologies adapted to the aging population. Aging friendly technology easily-accessible worldwide European Commission established for the period 2007-2013 should be created by taking into consideration the designing the programme “Europe for Citizens”. [4] for all. The „Design for All” concept is based on an The implementation of preventive policies like the understanding of design in which the shaping of the built effective use of ICT can raise awareness of aging people about environment is oriented towards people (human-centred design the possibilities and benefits the use of ICT can bring for them. approach). [5] It is a concept which consists of three strategies: The 2007 European Commission "Ageing • products/services and applications should be usable by Well in the Information Society" supports EU policy in the as many people as possible, regardless of age, ability or areas of growth and competitiveness. It presents an action plan situation, without any modifications. that considers ICT for aging well as both a social necessity and • products should be easily adaptable to different users. an economic opportunity. ICT technology represents a • products should have standardized interfaces, capable compulsory help for reaching a positive aging. [6] of being accessed by specialized user interaction devices. [8] IV. AGING FRIENDLY ICT TECHNOLOGY Designers are trying to fit ICT technology in the lives of A survey of the current literature reveals that recent the elderly and aging people, and make it as pleasant in use as technological advances have been made in the fields of possible. As an example there is gerontechnology, a "telecare and home-monitoring", "smart homes and robotics" combination of gerontology and technology. It’s designing and "health information systems and knowledge management". technology and environment for independent living and social Innovative technologies such as wearable devices, bio and participation of older persons in good health, comfort and environmental sensors and mobile, humanoid robots do safety. already exist and ambient assistant living environments are While ICT technology is rapidly being integrated into being created for an aging society. Services based on ICT most aspects of life, changing the nature of work, the form and technologies are already part of everyday life. [7] scope of personal communication, education, health care Research has shown that ICT technology can radically delivery, and home, aging people are highly likely to be active improve the quality of life of aging people. However, the users of technology. complexity and novelty of many new devices and services run Alongside a social objective, designing aging friendly the risk of rendering the majority of aging people unable to use ICT technology is also increasingly gaining an economic them. In the same time, with ever-changing advances, ICT perspective, as aging people have become an important technology often creates a divide between generations, customer group. isolating many seniors from the younger generation and from Knowing the needs of older consumers and considering key information and resources needed to function. these in the development and design of products and services Aging friendly ICT technology aims to further integrate promises competitive advantages and market success. elderly persons into society and reduce social isolation by working to increase access, capacity and knowledge of V. RESHAPING OUR MEDICAL INFORMATICS IN A SUSTAINABLE technology among this population. AND AGING PEOPLE-CENTERED MANNER In order to obtain a successful positive aging with the help of ICT technology, it is compulsory: Health is one of the most demanding issues for aging • to design new ICT technology for a better inclusion of people. This also extends to the design of medical these socially disadvantaged people, that would take applications; aiding memory, monitoring health conditions, into account their special needs; and supporting with distant family members • to identify key ways or roles that the aging people can are exemplary applications supporting elderly persons [9] play in the design process; In the nowadays society it’s more likely to find aging • to formulate user requirements for an appropriate people which suffers more from chronic conditions than acute design taking into consideration the cognitive, sensory or infectious diseases, and long-term community care is and psychomotor changes; frequently more appropriate than short-term hospital care. • to understand factors that influence elderly adoption There is an emerging public attitude towards a new concept and acceptance of technologies; of health, i.e. one that not only includes the treatment and • to train and support them, so that the technological prevention of disease, but also the promotion of health and barriers would be marginalized; wellness and the concept of personal responsibility for it. • to raise affordability (low cost of ICT technology); The use of ICT is becoming a self-evident part of the • to improve graphical icons so that their functions are development and delivery of healthcare services. In fact, it has easy for aging people to understand. Icons are very been proved that empowerment of the patients and technology important because they convey language and concepts have become critical elements of the healthcare of aging

64 INTERNATIONAL JOURNAL OF EDUCATION AND INFORMATION TECHNOLOGIES Issue 1, Volume 6, 2012 people. ICT technology has to be adapted to aging people's • the user interface must be adaptable. Aspects to self-care processes and coping strategies, and to support new consider when designing the user interface for ways of healthcare delivery. elderly users are readability and presentation of Medical informatics can support this process by providing information, navigation through the website, the necessary information infrastructure, contribute to incorporation of multimedia, and evaluation of standardisation, interoperability and security issues and system accessibility and friendliness. These include, provide modeling and simulation techniques for educational for example, simple and clear pages, clear navigation purposes. It helps clinicians and healthcare providers to make mechanisms, large buttons, large font sizes, complex information useful in supporting clinical decisions, conservative use of colours and avoidance of deep thus delivering the best standard of care for each patient. hierarchy in the information structure; Medical informatics has the potential not only to make the • the active involvement of future users of the provision of healthcare more efficient and cost-effective, but to application being developed (participatory design). encourage the independence of aging people and to improve Participation design is closely linked to patient their communication with doctors and other health empowerment and motivation to using the system. professionals. The benefits of medical informatics include the ability of Here are some examples of types of aging people–centered healthcare consumers to better manage their health. This can medical informatics: be achieved by the availability of modern healthcare tools such • Relational databases that facilitate the retrieval of data as web sites providing reliable healthcare information, Internet for multiple purposes; based health decision tools, online support groups, and • Manipulation of data to create information and personal health records. The operation of the healthcare knowledge; system will increasingly depend upon the acquisition, analysis • Health informatics systems used for: diagnostics and dissemination of reliable information. (internet consultations and telemonitoring), therapy Designing health informatics systems must take into (rehabilitation and telecare); account the evolving nature of the health domain and the aging • Point-of-care devices, computerized patient records of the population, a growing trend towards primary and and/or electronic health records; preventive care and the explosive growth in global networking. • Clinical repositories as a strategic resource for quality While, historically, storage and retrieval of data has been the and practice; main target for informatics systems development, the need to • Electronic interfacing systems to facilitate the sharing capture knowledge itself is becoming the focus for HEIS of data; development. • Acquisitions, storage, transmission, processing, analysis of digital images of the body and providing B. Study Case: AGECVD help to integrate those images in the various parts of The research project ”Complex Study of Metabolomics, the treatment; Genomics, Epigenetics of Age Related Atherosclerosis and • Virtual patient visits via video conference or vital sign Cardiovascular Pathology – AGECVD” is designing a monitoring; protocol of investigations, diagnosis, treatment and monitoring • Health education informatics systems for lifestyle of atherosclerosis and cardiovascular diseases specific of aging management. and it is developing a system of health information for

collecting and analyzing results of biomedical investigations A. Design recommendations for sustainable medical and psychosocial surveys. informatics Structural and functional changes of the cardiovascular The aging population has lagged behind younger system occurring in the course of aging are involved in generations in the adoption of ICT technology, including the increasing the risk of developing atherosclerotic processes and use of it for seeking and understanding health and medical cardiovascular diseases. Physiological aging as well as the information. Age differentials within the elderly population are atherosclerotic process is associated with a state of low important. In designing aging people-centered medical chronic inflammation and enhanced oxidative stress, which informatics, the following recommendations must be taken into suggest that pro-inflammatory cytokines and the balance consideration: between oxygen reactive species generation and antioxidant • the technology must be transparent to the elderly; defense play an important role in aging and atherosclerosis. • it has to be reliable and secure; Prevention and delay of changes associated with advancing age diminish the risk of developing cardiovascular diseases, • it should adapt to age disfunctionalities - the user’s thus enabling a healthy aging in the context of a continuously limitations (cognitive and motor) and impairment increasing average human life span. (visual and hearing) are important in inserting AGECVD is a research project developed inside the specific features; National Research, Development and Innovation Plan for the • it has to support the independence of aging people period 2007-2013 (NP II) is the main instrument by which the and empower them to control over their lives;

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Romanian National Authority for Scientific Research (NASR) important accent was put on usability and creating an open is implementing the National Strategy for RDI. informational space. AGECVD is a health informatics system that comprises an interconnected database system. It has an architecture that is structured into modules, allowing that new functionalities could be easily added. The problem of the technical accessibility is solved by using a web-based solution, a web browser being the only necessary condition for the user to connect to a system, with no need for other applications. It is a person-centric health informatics system with a high degree of flexibility because of dynamic and integrated structure that will accommodate to various health changable and needs of society in general and individuals in particular. To facilitate the access to information regardless of the user’s skills, there are provided clear navigation elements, perfectly adapted to the way in which links between pages are

established, which provides visual clues about their function Fig. 2 Main modules of AGECVD informatics and which helps to orientation. In terms of software architecture, the Model-View- Controller concept is used to ensure separation between user Objectives interface and objects that implement the logic of application. • establishing markers that predict the risk of This approach has allowed the independent testing of atherosclerotic processes developing and progressions’ application components. By using framework software Spring, as involved with aging related cardiovascular (CV) Acegi and Hibernate embedded in a single container we diseases and in view of a larger range of preventive managed to centralize and to manage automatically the strategies, which might contribute to elderly’s health configuration of application objects, thus ensuring the condition improvement; creating a framework to scalability of the implemented solution. facilitate transfer of data, information, knowledge; Results • supporting and providing arguments for the novelty of The practical results of AGECVD put into value: an integrative approach on aging related • the pointing to physiological aging newer markers and atherosclerotic processes that impact health condition predictive factors of developing atherosclerotic and life expectancy increase; establishing correlations processes in the course of aging; of metabolic, inflammatory status, oxidative stress • design of molecular target therapies; elaboration of a parameters, life style; complex protocol of investigations, diagnose and • establishing associations with genes implicated in treatment as resulted from statistical analysis methyl group metabolism pointing out newer correlations of obtained biomedical data; predictive/risk factors of developing atherosclerotic • application of the information technology in the processes and cardiovascular events in the course of research field of aging and large of care, access to aging; education, efficiency and time savings. • design of therapeutic strategies, particularly to prevent developing cardiovascular diseases with increased risks of mortality in the elderly; • dissemination of research outcome, organizing an open space for informing specialists and individuals of the general public with interests in preventing and treating causes of pathology induced aging; • continuous updating knowledge on atherosclerotic processes’ complexities and CV pathology by use of a health informatics application which ensures a higher degree of flexibility to changes and efficiency in handing over information. Methods For designing a health informatics application available on the internet able to load, store and for processing results of biomedical investigations, psychosocial survey, hence to facilitate dissemination of results, communication with specialists involved with the project and the general public, an

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communication strategy, according to the response and needs Fig, 3 Main page of AGECVD informatics system of the beneficiary to whom it is addressed. Objectives Information provided by this system meet the qualities that • creating an environment able to facilitate the gives it a high quality standard, namely: opportunity, knowledge, information and date circulation aiming an timeliness, accuracy, completeness, availability, validity, efficient management of the anti-aging domain; different ways of presentation. • supporting and motivating the actuality of the anti- The performances of this health informatics system take aging concept and increasing the quality in health into consideration the user-friendly interface, safety systems; functioning and data, high response time. • developing the informational space of the Romanian It is a system characterized by modularity, flexibility, state of health; platform independence, dynamism, accessibility, • putting into value the advantages offered by ICT multidisciplinary, interoperability and it respects the main regarding the accessibility of the information in the tendencies of developing the health informatics systems. anti-aging domain. This project is feasible because of its complex research Methods methodology, scientific and technical particularities, quality of AgingNice respects the main tendencies of developing information, accessibility, high performance, mainly in the informatics solutions for the health system, emphasizing the research topic of molecular medicine, genomics based interoperability as a must be demand to have an efficient methods of investigations and interventional methods and exchange of health data and knowledge. because of the multidisciplinary partnership. The used architecture is a Client Server type organized in three tiers and it has a structure composed from elements that C. Study Case: AgingNice can function autonomously, and which architectural Anti-aging represents a new concept that tackles the body requirements were developed both different types of users. health from another perspective – the one of preventing and Each module comprises several applications structured on treating the degenerative diseases with a therapeutic protocol levels for an optimal organization of information, according to elaborated by a team containing all of medical specialties. The the specific aimed objectives and it was qualitatively evaluated result consists in the delaying of the aging process and for its ability to be linked with the others and for its coverage. restoring the vitality of the mature body, but also an aesthetic The graphic user interface has an intuitive, ergonomic and appearance. friendly feature; it has a unique structure and it allows an easy Health promotion for the increasing aging population is an access to the functions and applications of the system. urgent and essential task because evidence indicates that health Results promotion interventions can extend longevity and improve AgingNice comprises tools and information concerning anti- quality of life. Health informatics systems can play an aging methods and strategies, clinical and laboratory important role in achieving wellbeing, independent living and investigations for aging preventing, anatomical modifications, delaying of the aging process and restoring the vitality of the educational models, self-evaluation tests, defining a mature body. [11] personalized demeanor, tendencies in the anti-aging Multidisciplinary Complex System for the Efficient biomedicine, anti-aging campaigns and applications for Management of the Anti-Aging Information (AgingNice) is a facilitating the dissemination of the therapeutic protocol, study research project developed inside the National Research, cases and recent research among the specialists.[12] Development and Innovation Plan for the period 2007-2013, AgingNice demonstrates that the information and between Sept. 2007 – Dec. 2010. communication technology has a deep integrator character, AgingNice is an open system that is ready to be integrated both at the level of the information management and at the one in the environment of the heterogeneous, comprehensive of the development of the modern health systems, putting national information system, available on many platforms and efficiently into value the opportunities offered by a fast with its capacity to interface with any existing or future accessibility. applications through direct access or web interface. Pervasive health education informatics systems generate The system can be implemented with minimal effort and no new challenges for knowledge management, data integration special claims regarding the electronic equipment. and education with huge benefits for citizen and society. The novelty of the project is primarily brought by the The multidisciplinary complex system for the efficient approached domain. management of the anti-aging information (AgingNice) creates Existing web applications in Romania focuses on the favourable conditions for the participation of all at the cosmetics, aesthetic and pharmaceutical fields of the anti-aging Information Society, including the groups exposed at risk of domain, and less on explaining the degenerative processes, exclusion because of their age. prevention and methods of reaching a active and healthy aging. A project like this one covers the so far insignificant use of ICT in the complexity of the anti-aging domain, focusing on presenting easy to understand information and adapting the

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• the understanding of the fact that, in terms of economic and financial, it is more effectively to prevent the degenerative diseases than to treat them, • the improvement of the specialized knowledge and the professional skills for increasing the performances, • the integration of the research, education and training activities with information technologies, • the changing of the attitude towards the age management, • the intensification of the collaboration among convergent specialties for considering thoroughly the anti-aging domain, • the facilitation of the communication among the professionals and between those and the citizens. Fig.4 AgingNice – Main page The project emphasizes the disseminating of the results of The use of the information technology in Romania in the the relevant research in the aging processes also by using the anti-aging domain is insignificant and it doesn’t cover the mobile communications technology to link to the Internet. specialists’ demands and the citizen’s need of informing. By presenting cosmetics products, the existing web applications in VI. OPPORTUNITIES BROUGHT BY AGING-FRIENDLY HEALTH this area center with priority on the aesthetic aspects of the EDUCATION INFORMATICS SYSTEMS aging. The physicians are interested in a domain with such implications, but they don’t have access to recent and Health Education Informatics Systems (HEIS) can bring centralized information. The stakeholders at the society level important opportunities for a better on quality and access to haven’t elaborated yet a perspective strategy concerning the health knowledge and education. The impact can be direct for prevention in this domain. citizens, or indirect, by enabling healthcare professionals to Given that the elderly are the biggest consumers of improve the quality and efficiency of healthcare that they resources in the health system and that their number is provide. growing, we appreciate that AgingNice, through the Benefits to quality consist in: information provided, structure and purpose can make an • Informed citizens and health professionals – they have important contribution to reduce costs at both individual and at direct access to data, information and knowledge about company level. [13] their conditions, diagnoses, treatment options and healthcare facilities, to enable them to take effective decisions about their health and lifestyles. • Information designed around the citizen - allows healthcare professionals to have access to more complete and focused information. As a result, they can be more centered-patient in their work. • Timeliness of healthcare - refers to appropriate timing of healthcare. This is not necessarily fast treatment. Information is used to emphasize the importance of preventive medicine to meet citizens’ needs. • Improved safety - information contributes to reducing risk, potential injuries and possible harm to patients to be minimised. • Effectiveness - making the best decision on the most appropriate healthcare depends on information about the possible service options and their outcomes, and these can be influenced by HEIS. Fig.5 AgingNice – “For Citizen Personalized Advice” Module HEIS can provide a vision of older people participating The extensive using of AgingNice will have as fully in decisions about their health and wellbeing and in social consequences: and community life. • the recognition of the timeliness and importance If health and disability support services are to play their of the concept of anti-aging, of the multiple part in enabling older people to live this vision, they need to implications of implementing the strategies related focus much more on: to the individual and society as a whole, • promoting wellness and quality of life to assist older people to age positively

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• working together to provide an integrated continuum • analyzing relative risks and benefits, of care so that an older person is able to access • calculating dosages, needed services at the right time, in the right place • interpreting test results, and from the right provider • locating health information. • providing community-level health care and disability In order to accomplish these tasks, individuals may need to support to enable older people to 'age in place' be: • the fact that the patients are increasingly responsible • visually literate (able to understand graphs or other for their healthcare decision-making. visual information), • the emergence and increasing availability of • computer literate (able to operate a computer), interactive information accessible to consumers. • information literate (able to obtain and apply • guaranteed validity and consistency of the available relevant information). information. Health Education Informatics Systems (HEIS) can make • using more efficiently the health care resources. the relevant information more accessible for doctors and other • a strengthening of the physician-patient relationship health care professionals and they can make the patients, the in which information flows in both directions. average citizens or the aging persons more informed about • bridging the digital divide and bringing consumer their own state of health and about the means to preserve it. health informatics to groups that have the greatest need. VII. CONCLUSIONS • directing consumers to high quality information and Aging means increased social capital and new attitudes to teach them how to assess the quality of towards the aging people which have changed and significantly information. differ from recent past. • guiding professionals and patients to use health In this changing society, to achieve a positive aging is an information in educationally appropriate ways. important goal, in order to improve people’s well being and • developing strategies to ensure high quality standards the society as a whole. in the publication of web based consumer health Aging people are becoming more accustomed to using information. information society services and at the same time older people To take full advantage of the opportunities brought by are a remarkable consumer group. aging-friendly health informatics systems, we have to pay Among all technologies, Information Technology is the more to health literacy go aging and older people. one that has a direct and constant influence on our lives. Our Health literacy means being able to find, process, and society is evolving around information technology, it is a understand basic health information and services needed to "information society", and we are witnessing the emergence of make appropriate health decisions. Health literacy is important a new culture – the digital culture. [14] because low health literacy is linked to poor health outcomes. As ICT technology develops and brings new innovations, it However, an international consensus is beginning to will be important to remain focused on the needs of aging emerge to define health literacy as a wide range of skills and users with respect to their computer access and use, and their abilities, reflecting the extent to which people are able to find, attitudes towards and acceptance of the technology. Issues understand, evaluate, communicate, and use health information such as ‘design for all’ complemented by participatory design and concepts to make informed choices, reduce health risks, will help to stimulate patient empowerment. reduce inequities in healthcare, and increase quality of life in a An aging population, increased longevity and co-morbidity variety of settings across the life course. of diseases have put enormous pressure on health care systems Health literacy is not simply the ability to read. It requires a globally. Innovative ways to address this strain are needed. complex group of reading, listening, analytical, and decision- By understanding the characteristics, demands and needs of making skills, and the ability to apply these skills to health aging people and including them in the design process, situations. medical informatics can be developed to circumvent Health literacy varies by context and setting and is not difficulties, maximize the usability and usefulness of products necessarily related to years of education or general reading and technologies, hence supporting successful positive aging. ability. A person who functions adequately at home or work may have marginal or inadequate literacy in a health care environment. With the move towards a more "consumer- REFERENCES centric" health care system as part of an overall effort to [1] Fisk, A. D., Rogers, W. A., Charness, N., Czaja, S. J., & Sharit, J. improve the quality of health care and to reduce health care (2009). Designing for older adults: Principles and creative human costs, individuals need to take an even more active role in factors approaches health care related decisions. To accomplish this people need [2] Ianculescu M., Parvan M.: ”E-health, a Crucial Catalyst for Changing strong health information skills. the Future of Aging”, The 31st National Conference on Medical Informatics 2010, pag. 28-34. Aging persons are often faced with complex information [3] Ann Bowling: The Concepts of Successful and Positive Ageing, Oxford and treatment decisions. Some of the specific tasks aging Journals Medicine & Family Practice, Vol. 10, Issue 4, Pp 449 persons are required to carry out may include: [4] Decision 1904/2006/EC of the European Parliament and the Council • evaluating information for credibility and quality, establishing the programme “Europe for Citizens”

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[5] 12.10.2006 COM(2006) 571 final COMMISSION COMMUNICATION “The demographic future of Europe – from challenge to opportunity”(page 4) [6] http://eur-lex.europa.eu/LexUriServ/site/en/com/ 2007/com2007 _0332 en01.pdf [7] Yeunsook Lee, Z Bien, Mounir Mokhtari, Jeong Kim: Aging Friendly Technology for Health and Independence (2010) Volume: 6159, Publisher: Springer Berlin Heidelberg, Pages: 263-266, [8] Laura Burzagli, Pier Luigi Emiliani, Francesco Gabbanini: Design for All in action: An example of analysis and implementation, Published in: l Expert Systems with Applications: An International Journal Volume 36 Issue 2, 2009 [9] Charness, N., D. C. Parks, et al., Eds. (2001). Communication, technology and aging: opportunities and challenges for the future. New York:, Springer Pub. [10] Ianculescu M., Parvan M.: ”E-health, a Crucial Catalyst for Changing the Future of Aging”, The 31st National Conference on Medical Informatics 2010, pag. 28-34. [11] Marilena Ianculescu: “The Imperative Role of ICI for Supporting Aging with Dignity”, The 15th WSEAS International Conference on COMPUTERS” (Part of the 15th WSEAS CSCC Multiconference), pag. 124-128 [12] Marilena Ianculescu, Monica Parvan, ”Striving After a Truly Citizen- Driven Society in the Age of Aging. Study Case: AgingNice, a Health Education Information System”, The WSEAS International Conference on APPLIED COMPUTING CONFERENCE (ACC’)”, 2010, TimiVoara, Romania, pag. 49-53. [13] Marilena Ianculescu, Monica Parvan, Bogdan Iordache: “Enhancing the Patient Empowerment Due to the ICT and Ethical Aspects Involved”, The 12th WSEAS International Conference on COMPUTERS (part of the 12th WSEAS CSCC Multiconference) “New Aspects of Computers Part: III”, 2008, Heraklion, Greece, pag. 787-792 [14] Ioana Moisil – Digital Culture Impact on Education, LATEST TRENDS on ENGINEERING EDUCATION- 7th WSEAS International Conference on ENGINEERING EDUCATION (EDUCATION '10), 2010

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